Monday, November 23, 2009

The Cost of Dying

60 Minutes had an excellent segment Sunday on "The Cost of Dying" -- how Medicare (and by extension, we the taxpayers) spent $50 billion, more than the budget for the Department of Homeland Security or the Department of Education, on end-of-life treatment, doctor and hospital bills during the last two months of a patient's life.

They're talking about people with terminal illnesses whose lives are prolonged in ICUs at a cost of about $10,000 a day.  That might sound crass, but, in many cases, it's treatment that doesn't do much good, that only delays an inevitable death.
"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it's having someone you love die badly," (Dr. Ira) Byock (of the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.) said.

Asked what he means by "die badly," Byock told Kroft, "Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that's collectively what we're doing."

A vast majority of Americans say they want to die at home, but 75 percent die in a hospital or a nursing home.
We've heard all the diatribes from the tea-baggers -- rationing, death panels, and pulling the plug on grandma -- and thus this topic has become off-limits, but...
Multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management.

"The real problem is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home. They'd prefer to go to hospice. If they were given a choice. But we don't adequately give them a choice," (Dr. Elliott) Fisher (of the Dartmouth Institute for Health Policy) said.

"At some point, most doctors know that a patient's not likely to get better," Kroft remarked.

"Absolutely," Fisher agreed. "Sometimes there's a good conversation. Often there's not. You know, patients are left alone to sort of figure it out themselves."

Read the story or watch the video.  There are also two short web extra videos, "At Home, At Peace" and "Comfort and Costs."

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Lisa :-] said...


This is sore point with me.

If Medicare is spending billions of dollars on medical care to keep dying elderly folks alive, it certainly isn't here in Oregon.

My dad died of cancer ten years ago. The Medicare coverage he got was horrible. The care he got was horrible. It was a nightmare. It boiled down to his being mis-diagnosed until it was too late to do anything really effective, then being subjected to a radical surgery and basically being sent home to die. When we took him to the hospital a few days before he died (at the behest of his hospice nurse) they all but threw him out. Basically said, "We can't do anything for you here,. Go home and die." So he did. It was probably the best choice, but it was not presented as a "choice." We were not offered alternatives or any kind of "end of life" counseling at all.

So when I hear these idiots whining about "unplugging Grandma" and death panels and all that rot, I wonder what country THEY live in, because it certainly isn't this one. Because this kind of "you aren't worth the treatment" culture already exists. Has existed for at least a decade, in my experience, and has probably existed since shortly after the creation of the HMO...

fdtate said...

I'm very sorry about the experience you had with your dad. I had almost the exact opposite experience a few months back with my mother-in-law. Although she was only in her mid-60s, she was in terrible physical shape and had been sick for many years. Modern medicine prolonged her life, but, in my opinion, made the end a lot more gruesome and horrible than it should have been. The only bright spot was that she did get good hospice care and was able to die at home as she wished.

Lisa :-] said...

I wonder if there isn't a "cut-off" age, written down secretly somewhere. Mid-sixties is relatively young. My dad was seventy-nine when he died. I really got the sense that there was a limited amount of care he was going to have access to, whether he wanted it or not.

Our entire interpretation of the art of healing is so far off the mark that we often do more harm than good. We have no idea when to intervene and when to let nature take its course. The decisions we make are haphazard, often wrong, and based upon things that should never enter into the process-like the almoighty dollar.